Provider Demographics
NPI:1780109546
Name:O'HANLON, EUGENE PATRICK (PT, DPT)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:PATRICK
Last Name:O'HANLON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:311 CONGRESS PKWY N STE 800
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-1697
Practice Address - Country:US
Practice Address - Phone:423-744-0890
Practice Address - Fax:423-744-0894
Is Sole Proprietor?:No
Enumeration Date:2017-08-13
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05781225100000X
GAPT013059225100000X
TN11805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist